The trouble with nursing

I have been in contact with several people in nursing in Germany, who seem disappointed and hurt and wondering why they should continue to use their life energy for others. I understand their disappointment because I have been through the same thing, even in management, and I could do little to change the situation. It is indeed the case that nursing in Germany, in which reliability and compassion are important qualities, has been made into a profession like any other, and in the process the authorities overlook (or ignore) the complexity of the task as well as the strain on the body and mind. This is especially the case when it comes to caring for people with degenerative diseases. These seems to be a problem internationally.

Many young people enter this profession and find that the little bit of extra money they earn as a Licensed Practical Nurse over the auxiliary nurse is not motivation enough to take on the stress of the task. In my experience, the demands of the profession are assessed academically, even though the vast majority of professionals are not academics. The problem is not keeping sick people satiated and clean, that is basically the easiest thing to do, but the problem is caring for them appropriately. By appropriate care I mean holistic nursing, taking into account all their needs – which is a very difficult task. It’s not just manual work, or writing extensive care-planning, it’s also relationship work, and for that you need time and tact.

From my experience, if you want to fulfil this task, you have to accept that you cannot provide optimal care in the full sense of the word, because the conditions are not optimal. So, an optimum is not a benchmark, but a goal to strive for. In order to achieve this goal to some extent, it is necessary to have coherent teamwork and a division of tasks that respects the special role of the registered colleagues. Auxiliary nurses must take their cues from the licensed nurses and work towards their declared goals, and these should in turn value that work, without which they achieve their aims.

In Germany, there are many people in nursing who are burned out, and this isn’t just because of the pandemic, which only served to deepen the divide between goals and resources. Often it is not only the tiring work, but the fact that they are under multiple pressures (children, elderly parents, and sometime a reliant husband) that make their lives difficult. I have known many female employees who have (or had) so much to carry in their lives that they no longer had energy for the job. When you carry a life situation like that long enough, you dull down and distribute what energy you have left to tasks.

In Germany, temp work has become widespread, and many licensed nurses have realised that they can have the full pay through temp work, without the full responsibility of resident nurses. Then it’s clear where people are going if they don’t value continuity and a permanent contract. That is demotivating for the professionals in the facilities, and in the end, it can happen that you can only get professionals from temporary employment agencies. This can quickly develop to a facility having to close because it no longer meets the requirements of the authorities.

In a way, you can look at it like this: Basically, no matter what team sport you play or what tasks a team has to accomplish, you need a reasonable game plan that everyone has to stick to. This includes being clear as a team about what the overall task is, what the difficulties are, and how to avoid conceding goals. Of course, it’s also about scoring “scorer points,” but you have to be clear in the workspace what those are. In soccer, it’s easy to define: Putting the ball in the opponent’s goal as often as possible, but the strikers need to keep an eye on the whole game and provide support when needed so that the whole team produces a satisfactory work performance.

With any defined role or task, a team is only as successful as the team effort makes it. It does no good to devise great tactics if no one sticks to them. It’s also no use scoring goals but conceding more of them. If we concede goals, we have to do more unnecessary work. Every member of the team must be clear about their role and do it well, but also follow the “play” and iron out problems with the rest of the team. In our age of individualism, we tend more and more to put our own performance above the performance of the team, but as a team you win and as a team you lose.

In geriatric care in Germany, the residents and family members, as well as the reviewing authorities, are the spectators and referees, and as we know, there are whistles and boos and point deductions when we consistently perform poorly. As in sports, we also get attacked by a sensationalist press when we perform very poorly. We have to perform every day, which makes geriatric care look worse than sports teams that only have to play once or twice a week. Our playing time is also longer than 90 minutes, which means we have to think very carefully about how we perform as a team and look for improvement every day.

Leaders also need to keep a good connection with their teams and not put themselves above the team, but the team also needs to respect the work of the leadership and honour agreements. The moment the process doesn’t work, it’s often the leadership that gets the criticism. This makes it all the more important to clarify what position one takes on the process, what expectations one is overwhelmed with, but also how the team’s expectations can be met. The discussion should be open, but once an agreement has been reached, it must be honoured. It’s better to argue up front than when doing the work.

I believe if you don’t have that attitude towards the task, the job can’t get done, and we all have to work to stay fit for the game. Unfortunately, if you’re not willing to do that, you’re not fit for the task. As in sports, it may be the body that is not up to the task, possibly due to a strong performance in the past. It is noticeable that in nursing there are always typical sports injuries that increase with age.

So, the question is, are you ready to approach the job that way? I wish there were times when these demands weren’t made, but I also know of times when I’ve walked down the ward with my team after work is done and had “We are the champions” on my lips.

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